Be an agent of progress rather than a victim of change

Chris Hogan

12/01/2022 3:48:29 PM

Associate Professor Chris Hogan offers some advice for medical students considering a career in general practice ahead of their final year.

Stethoscope placed on top of medical text books.
Medical knowledge is transient and has a use-by date of about three years, writes Associate Professor Chris Hogan.

In COVID times, when it is easy to be overwhelmed by the difficulties of practice, it serves as a reminder to us of how wonderful general practice can be.

As final year students, this clinical rotation is the most important part of your medical course, which is why it is put last.
You have spent the past few years of your life learning about the bits that make up a human being.
This is where it all makes sense.
You have learnt about the structure and function of humans in health and in sickness.
You have learnt about anatomy, physiology and pathology.
You have learnt about therapeutics, medicine, surgery and psychiatry.
Your learning has been broken up into segments because that is the only way you can learn.
Now we deal with it all, we integrate it. General practice crosses all disciplines.
You have learnt about the human and the treatment of patients – now we show you how to deal with people and their health.
Knowledge is transient
The knowledge that you have acquired is important and wonderful. Congratulations on achieving it.
But, and this is a big but, a lot of what you have learned so far is transient. It will become outdated.
Medical information has a use-by date which I suspect is about 2−3 years. 
Welcome to a lifetime of learning
Half in jest, half in harsh reality, it is said that the final year exam questions are the same year to year − only the answers change.
The questions are consistent because those topics are important. The answers change for three very important reasons:

  1. Our knowledge of health and of sicknesses expands
  2. Our knowledge of diseases and treatments change
  3. The diseases themselves change
I feel that it is important to be an agent of progress rather than a victim of change, so I encourage you to become involved in teaching and research, when you are ready.
This rotation is different and special
You will have very close contact for several weeks with senior consultants. Do not waste this opportunity to observe and ask questions. You will draw on all your skills and learning.
You will see people more than once and get to know them in their context of family, culture, knowledge and relationships.
You will see well people and try to keep them well, sick people you will try to help, and people whose health status is uncertain. You will learn that it is easier to treat a heart attack than it is to treat someone who is sick at heart.
The medical course is crowded – it always has been, and I doubt it will change.
Goals for the general practice term
You have several aims for the term.
  • To get a taste of the skills and complexity of general practice. It takes several years after graduation to be confident in using your skills
  • To learn about the role of general practice in the Australian health system
  • To learn about the complexity of the Australian health system: primary, secondary and tertiary care, and to learn how to use the system for your patient’s best advantage
  • To understand the importance of working in teams
  • To utilise this safe and supportive environment to practice the skills you will use in a few short weeks when you become an intern
Is general practice perfect?
No, but it is a lot better than you might think.
You have been in teaching hospitals and seen the failures and mistakes of some GPs.

The work of a good GP is invisible, but the work of a not-so-good GP, not so much.
General practice is a discipline that is observed and scrutinised like no other. Many think it is easy, but as the ancient Greeks said, ‘Only the ignorant are certain’.
The late Barbara Starfield, American advocate for primary healthcare, was able to clearly demonstrate that the more a health system relies on primary care doctors the better are its health outcomes, and conversely, the more a health system relies on specialist care doctors the worse are its health outcomes.
Australian general practice is alive and is dealing with changes and challenges as well as, if not better than, our predecessors.
However, as always, the price of freedom is eternal vigilance.
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